- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,168.00 / $26,771.40 / $34,112.60
| Facility | | $17,168.00 | $26,771.40 | $34,112.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,189.74 / $41,189.74 / $41,189.74
| Facility | | $41,189.74 | $41,189.74 | $41,189.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,349.84 / $27,423.83 / $32,301.72
| Facility | | $15,349.84 | $27,423.83 | $32,301.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,612.45 / $27,812.11 / $38,962.73
| Facility | | $14,612.45 | $27,812.11 | $38,962.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,428.68 / $30,339.15 / $38,962.73
| Facility | | $26,428.68 | $30,339.15 | $38,962.73 |